Even children of leprosy patients, whose address is a leprosy colony are denied jobs. Such programs inadvertently enhance the negative image. Even the frontline health workers are looked down by the general public leading to demoralization of these workers.
Leprosy continues to be regarded as a divine curse, or punishment for sins even among some of those who are aware of the nature and cause of the disease. In the name of religion, people are exploited shamed and ostracized. PALs are often made to spend money for visiting holy places to appease the goddesses, atone for sins and undergo various rituals. Figure 1.
One of the ways to overcome these socio- economic- cultural problems is through the community based primary health care approach (PHC) . The PHC approach is a holistic approach whereby health professionals and people work in partnership to bring about positive health. Leprosy can be well integrated into the overall PHC program.
The main components of the PHC program are community participation and empowerment. PHC approach includes the integration of preventive, promotive, curative and rehabilitation services, multi-sectoral collaboration and appropriate technology.
Community Participation is one of the key concepts of the primary health care approach in achieving health for all, as expressed at Alma Ata in 1978. 1 Primary health care is ultimately about empowerment of individuals and community so they have control over their own health and lives. This was more well defined at Riga2 as Empower people by providing information, technical support and decision-making possibilities, so as to enable them to share in opportunities and responsibilities for action in the interest of their own health. Give special attention to the role of women in health and development.
This means the involvement of communities in the development of services so as to promote self-reliance and reduce dependency. This can be done only through empowerment of people. Community participation is not people just responding to services planned and implemented by experts from outside. It does not mean people passively following the health messages provided by the health professionals through health education and mass media. It means people being fully involved in the whole process of planning, implementation, monitoring and review of health programmes. It means people taking control. This is where primary health care approach differs from traditional public health approaches.
The question that is often asked is how can people participate in such a technical matter as health and in particular leprosy? The reality in leprosy is that a large proportion of the complications of leprosy are preventable. Leprosy patients can lead normal lives in dignity provided they take a few simple precautions. No matter how good and efficient leprosy service provided by the health professional is, it is up to the individual or family to utilize the information and knowledge. In short people have to realize that they are the key actors in health and not the medical profession and the medical profession has to realize that the
1 Report of the International Conference on Primary Health care Alma-Ata. USSR, 6-12 September 1978. Jointly
sponsored by WHO and UNICEF
2 From Alma-Ata to the year 2000. Reflections at the mid-point. WHO 1988
